Diagnostic Assessment — Skin - Tinea
Example 1 of 1 · fictitious patient (Veteran J)
Diagnostic Assessment
Skin - Tinea
SOP 56/2024 (Balance of Probabilities) SOP 55/2024 (Reasonable Hypothesis)
ADF History
The veteran, Medic/Medical Operator/Medical Technician, 06 December 2001, 23 Mar 2022.
Occupational History
As an Army Medic, the veteran was exposed to numerous occupational hazards throughout her career including working in tropical environments with high humidity and temperature, prolonged wearing of occlusive military footwear and clothing, use of communal showering and bathing facilities in barracks and deployment locations, exposure to contaminated surfaces and equipment, and field conditions with limited hygiene facilities. Her postings to tropical locations including the base city and deployments to an overseas deployment location created ideal conditions for fungal growth and transmission.
History
The veteran an Army Medic, developed tinea infection in Apr 2014 during her posting to the base city, the territory. The infection occurred in the context of tropical environmental conditions and military service factors that predisposed to fungal infections.
Timeline
- 12 Feb 2013: Tinea noted during medical consultation. The veteran presented with characteristic fungal skin infection during her the base city posting. The tropical environment with high humidity and temperature created ideal conditions for dermatophyte growth. Her military duties required prolonged wearing of occlusive boots and clothing, which contributed to skin maceration and increased infection risk. The use of communal shower facilities and shared training areas in military accommodation increased her exposure to contaminated surfaces. Clinical examination revealed typical scaly, erythematous patches consistent with dermatophyte infection. The diagnosis was made clinically based on characteristic appearance and distribution. Treatment with topical antifungal cream was prescribed along with education on preventive measures including proper foot hygiene and use of antifungal powder in military boots.
Symptoms
At the time of infection, the veteran experienced itching and burning sensation of the affected skin areas, which was worse with sweating during physical training and duty activities. The symptoms interfered with the wearing of military equipment and uniforms. From the current documentation, there is no evidence of ongoing tinea infection, suggesting successful treatment and resolution of the acute episode.
Imaging
No imaging was performed for this condition as diagnosis was made clinically based on characteristic appearance.
1. What is the formal diagnosis of the condition claimed above?
Tinea, SOP 56/2024 (Balance of Probabilities), SOP 55/2024 (Reasonable Hypothesis), ICD-10 code B35.
Tinea is a fungal infection of the skin, hair, or nails caused by dermatophytes including Epidermophyton, Trichophyton, and Microsporum species. These fungi have a predilection for keratinized tissues and thrive in warm, moist environments. The infection typically presents as scaly, erythematous patches with active borders and central clearing. Common sites include the feet (tinea pedis), groin (tinea cruris), body (tinea corporis), and scalp (tinea capitis). Risk factors include occlusive footwear, communal facilities, immunocompromise, and tropical climates. Diagnosis is usually clinical but can be confirmed with KOH preparation or fungal culture. Treatment involves topical or systemic antifungal medications depending on the site and severity of infection.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
The veteran first experienced symptoms of tinea infection in Apr 2014 [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, page multiple].
When did the veteran first present to a health / medical provider for this condition?
The veteran first presented for medical assessment on 12 February 2013 to military medical staff [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, page multiple].
When was the condition confirmed / formally diagnosed?
The condition was diagnosed clinically on 12 February 2013 by military medical staff based on characteristic clinical appearance [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, page multiple].
When did the veteran first present to you (or your practice) for this condition?
22 November 2020.
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions? Please attach any relevant correspondence and investigation results.
The diagnosis was confirmed clinically based on characteristic presentation of fungal skin infection. Key symptoms included itching and burning sensation of the affected skin areas, worse with sweating during military activities. Clinical signs included scaly, erythematous patches with typical dermatophyte appearance. No laboratory investigations were required as the clinical presentation was pathognomonic. Treatment response to topical antifungal medication confirmed the diagnosis [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, page multiple].
4. What do you consider to be the cause(s) of the condition in this veteran? Give consideration to constitutional and common risk factors, pre-existing injuries or diseases, and occupational or lifestyle risks, as well as direct causative mechanisms.
Having unprotected physical contact with objects or surfaces contaminated with dermatophytes; using communal showering or bathing facilities, swimming pool facilities or locker rooms; between 2 days and 3 weeks before the clinical onset or clinical worsening - MET
- The veteran used communal showering and bathing facilities in military barracks and training areas. Military accommodation necessarily involves shared facilities including showers, bathrooms, and locker rooms. Her the base city posting involved regular use of these facilities where dermatophyte contamination is common.
Having skin maceration at the affected site between 2 days and 3 weeks before the clinical worsening - MET
- Military service required prolonged wearing of occlusive footwear and clothing, particularly in the tropical the base city environment. This created conditions of persistent moisture and heat leading to skin maceration, making the skin more susceptible to fungal invasion.
Having diabetes mellitus at the time of clinical worsening - NOT MET
- No evidence of diabetes mellitus documented in the veteran medical records.
Having a substantially lowered immune function at the time of clinical worsening - NOT MET
- No evidence of immunocompromise documented at the time of infection.
Having topical glucocorticoid applied at the site of the tinea at the time of clinical worsening - NOT MET
- No documentation of topical steroid use prior to infection.
Having chronic renal failure at the time of clinical worsening of tinea unguium - NOT MET
- This factor applies only to nail infections and no renal failure was documented.
Taking risankizumab and guselkumab at the time of clinical worsening - NOT MET
- No documentation of these medications.
Having peripheral artery disease of the lower limb at the time of clinical worsening of tinea affecting the foot - NOT MET
- No peripheral vascular disease documented.
Having chronic venous insufficiency of the lower limb at the time of clinical worsening of tinea unguium of the toes - NOT MET
- No venous insufficiency documented and this factor applies to nail infections.
Having varicose veins of the lower limb at the time of clinical worsening of tinea unguium of the toes - NOT MET
- No varicose veins documented and this factor applies to nail infections.
Having shaved the skin at the affected site within 3 weeks of clinical worsening (RH only) - NOT MET
- No documentation of recent shaving at the affected site.
Inability to obtain appropriate clinical management for tinea before clinical worsening - NOT MET
- This was the initial presentation without prior episodes requiring treatment.
Sequelae
This condition is not a sequelae of another known condition but rather represents a primary fungal infection related to military service environmental exposures.
Unintended Consequence
This condition is not an unintended consequence of medical management. No procedures were performed or medications given that resulted in this infection.
Inability to Attain Appropriate Medical Management
The veteran received appropriate and timely medical management for her tinea infection. She presented promptly when symptoms developed and received appropriate antifungal treatment. The Full Federal Court in Brew v Repatriation Commission (20 May 1996) enlarges on the meaning of "inability" as the lack of ability to get treatment in both objective and subjective senses. In this case, there were no barriers to accessing appropriate medical care, and the condition was managed appropriately according to clinical standards of the time.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
